• Journal of Periodontal and Implant Science
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• v.29 no.3
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• pp.539-553
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• 1999

The purpose of this 6-months study was to compare the clinical and radiographic outcomes following guided tissue regeneration treating human mandibular Class II furcation defects with a bioabsorbable BioMesh barrier(test treatment) or a nonabsorbable ePTFE barrier(control treatment). Fourteen defects in 14 patients(mean age 44 years) were treated with BioMesh barriers and ten defects in 10 patients(mean age 48 years) with ePTFE barriers. After initial therapy, a GTR procedure was done. Following flap elevation, root planing, and removal of granulation tissue, each device was adjusted to cover the furcation defect. The flaps were repositioned and sutured to complete coverage of the barriers. A second surgical procedure was performed at control sites after 4 to 6 weeks to remove the nonresorbable barrier. Radiographic and clinical examinations(plaque index, gingival index, tooth mobility, gingival margin position, pocket depth, clinical attachment level) were carried out under standardized conditions immediately before and 6 months after surgery. Furthermore, digital subtraction radiography was carried out. All areas healed uneventfully. Surgical treatment resulted in clinically and statistically equivalent changes when comparisons were made between test and control treatments. Changes in plaque index were 0.7 for test and 0.4 for control treatments; changes in gingival index were 0.9 and 0.5. In both group gingival margin position and pocket depth reduction was 1.0mm and 3.0mm; clinical attachment level gain was 1.9mm. There were no changes in tooth mobility and the bone in radiographic evaluation. No significant(p${\leq }$0.05) difference between the two membranes could be detected with regard to plaque index, gingival index, gingival margin position, pocket depth, and clinical attachment level. In conclusion, a bioabsorbable BioMesh membrane is effective in human mandibular Class II furcation defects and a longer period study is needed to fully evaluate the outcomes.

• Journal of Periodontal and Implant Science
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• v.47 no.6
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• pp.352-362
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• 2017

Purpose: Furcation involvement in the molars is difficult to treat, and has been recognized as a risk factor for tooth loss. Although periodontal regenerative therapies, including guided tissue regeneration and various types of bone grafts, have been applied to furcation defects, the effects of these treatments are limited, especially in large class III furcation defects. The purpose of this pilot study was to investigate the effect of reciprocal autologous root transplantation on periodontal wound healing and regeneration in class III furcation defects in dogs. Methods: Furcation defects (7 mm wide and 6 mm high) were surgically created after root separation of the unilateral third and fourth premolars in 4 dogs. Eight furcation defects were randomized to receive either reciprocal autologous root transplantation (test) or no further treatment (control). In the test group, the mesial and distal roots were transplanted into the distal and mesial extraction sockets, respectively. The animals were sacrificed 10 weeks after surgery for histologic evaluation. Results: The healing pattern in the control group was characterized by extensive collapse of the flap and limited periodontal regeneration. New bone formation in the test group ($3.56{\pm}0.57mm$) was significantly greater than in the control group ($0.62{\pm}0.21mm$). Dense collagen fibers inserting into the residual cementum on the transplanted root surfaces were observed in the test group. Slight ankylosis was observed in 2 of the 4 specimens in the test group on the mesiodistal sides where the root-planed surfaces faced the existing bone. Root resorption (RR) was detected in both the control and test groups. Conclusions: Within the limits of this study, it can be concluded that reciprocal autologous root transplantation was effective for bone regeneration in class III furcation defects in dogs. However, further studies are required to standardize the approach in order to prevent unwanted RR prior to clinical application.

• Journal of Periodontal and Implant Science
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• v.30 no.4
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• pp.803-814
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• 2000

Current acceptable methods of promoting periodontal regeneration are basis of removal of diseased soft tissue, root treatment, guided tissue regeneration, graft materials, biological mediators. Platelet Rich Plasma have been reported as a biological mediator which regulate activities of wound healing progress including cell proliferation, migration, and metabolism. The purpose of this study is to evaluate the possibility of using the Platelet Rich Plasma as a regeneration promoting agent for furcation involvement defect. Five adult beagle dogs were used in this experiment. With intrasulcular and crestal incision, mucoperiosteal flap was elevated. Following decortication with 1/2 high speed round bur, degree II furcation defect was made on mandibular third(P3), forth(P4) and fifth(P5) premolar. 2 month later experimental group were PRP plus bovine bone and bovine bone only. After 4, 8 weeks, the animals were sacrificed by perfusion technique. Tissue block was excised including the tooth and prepared for light microscope with Gomori's trichrome staining. At 4 weeks after surgery, there were rapid osteogenesis phenomenon on the defected area of the Platelet Rich Plasma plus bovine bone group and early trabeculation pattern was made with new osteoid tissue produced by activated osteoblast. Bone formation was almost completed to the fornix of furcation by 4 weeks after surgery. In conclusion, Platelet Rich Plasma can promote rapid osteogenesis during early stage of periodontal tissue regeneration.

• Journal of Periodontal and Implant Science
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• v.31 no.2
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• pp.421-436
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• 2001

Transforming growth $factor-{\beta}(TGF-{\beta})$is a polypeptide biologic mediator considered to play a role in promoting bone formation in bony defect area. The purpose of this study was to examine the effect of $TGF-{\beta}$ to the periodontal regeneration of class III furcation defect in dogs. Classs III furcation defects were surgically created on the third and the fourth premolars bilaterally in the mandibles of eight mongrel dogs. Experimental periodontitis were induced by placing small cotton pellets into the created defects for 3 weeks. Experimental sites were divided into 4 groups according to the treatment modalities: Group I-Surgical debridement only; Group II-allogenic demineralized freeze dried bone grafting; Group III-allogenic demineralized freeze dried bone soaked in $TGF-{\beta}(4ng/10{\mu}l)$grafting; Group IV-allogenic demineralized freeze dried bone soaked in $TGF-{\beta}(20ng/10{\mu}l)$ grafting. The animals were sacrificed in the 8th week after periodontal surgery and the decalcified and undecalcified specimens were for histological and histometric examination. Although no significant differences was seen in the length of epitheial growth and connective attachment, group III showed the least apical migration among treatment groups. The amount of bone repair was significantly greater in group III, IV compared to group I and group II. New attachment formation was significantly greater in group III and group IV compared to group I and group II. These results suggest the allogenic demineralized freeze dried bone with $TGF-{\beta}$ in class III furcation defect has the potentiality of promoting alveolar bone formation and periodontal regeneration.

• Journal of Periodontal and Implant Science
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• v.35 no.4
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• pp.877-889
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• 2005

This study was designed to compare the effects of treatment using chitosan membrane $(Nanogide-C^{(R)})$ resorbable barrier with control treated by polylactic acid/polylacticglycolic acid membrane(PLA/PLGA membrane, $Biomesh^{(R)}$). 44 furcation defecs from 44 patients with class 2 furcation degree were used for this study, 22 sites of them were treated by chitosan membrane as experimental group and 22 site were treated by PLA/PLGA membrane as control group. Clinical parameters including probing depth, gingival recession, attachment level and radiographic examination were evlauated at base line, 1 month, 2 month and 3 month. after surgery. Statistical test used to analyze these data included paired t-test, one way ANOVA. The results are as follows : 1. Probing depth was significanlly decreased in the two group and there were significant differences between groups(p<0.05). 2. Gingival recession was not significanlly increased in the two group and there were no significant differences between groups(p<0.05). 3. Loss of attachment was statistically decreased in the two group and there were no significant differences between groups(p<0.05). 4. Horizontal bone level was significanlly increased in the two group and there were significant differences between groups(p<0.05). On the basis of these results, chitoans resorbable membrane has similar potential to PLA/PLGA membrane in GTR for furcation defect.

• Journal of Periodontal and Implant Science
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• v.36 no.4
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• pp.809-816
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• 2006

Periodontal disease accompany the inflammation around periodontal tissue and generally periodontal destruction is followed, This destruction often makes the molar teeth have furcation defect. And to treat molar furcation involvement, resective surgery such as root resection and ostectomy and regenerative procedure such as guided tissue regeneration were introduced. Also implant can be considered as one of the good treatment methods, Among these treatment alternatives, root resection can be considered as a good procedure in the point of saving one's natural teeth or amount of cost. Therefore the purpose of this article is to evaluate root-resected teeth which were done at least 2 years ago. 70 root-resected teeth in 58 patient who visited Kyungpook National University Hospital were included in this study. They were evaluated by two clinical method. One is subjective evaluation and another is objective evaluation. To evaluate subjective outcome, 58 patients answered to the questionnaire if they experienced tooth extraction, bleeding, swelling, pain, mobility and chewing problem. To evaluate objective outcome, 28 teeth was evaluated according to Langer's criteria. The subjective result showed 82% of success rate and 18% of failure rate. 13 of 70 teeth showed discomfort and were considered as failure, which include chewing problem (39%) and pain (23%). The objective outcome showed that 4 failure (14% failure rate) which were 2 cases of bone loss by periodontal problem, one endodontic problem and one untreatable caries. By these limited results, some of clinical consideration in root resective procedure can be suggested. Periodontal support and less occlusal loading on resected tooth should be evaluated before the procedure, moreover, good oral hygiene is essential. When these factors are considered carefully, the root resection may produce predictive outcomes in the treatment of furcational involvement.

• 대한치주과학회:학술대회논문집
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• 2000.11a
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• pp.73-74
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• 2000

• Journal of Periodontal and Implant Science
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• v.36 no.2
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• pp.515-529
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• 2006

Periodontal regeneration refers to the restoration of bone, cementum and periodontal ligament to their original levels before damage from periodontal disease process. Various surgical techniques to the promotion of periodontal regeneration have been used. Bone graft and guided tissue regeneration have used for the regeneration of furcation involvements which caused by periodontal disease. Fibrin adhesive is agents that have been shown to be effective in periodontal regeneration and biological carrier. Calcium sulfate which is one of the resorbable barrier materials has used for guided tissue regeneration. The purpose of this study was to compare the clinical effects between bone graft using fibrin adhesive and calcium sulfate barrier in the mandibular class II furcation involvement. For the study, twenty-six class II furcation involved teeth were surgically treated. 13 furcation defects(test group) were treated with bonegraft and fibrin adhesive and the others(control group) were treated with bone graft and calcium sulfate barrier. Pocket depth, clinical attachment level and gingival recession were measured at baseline, postoperative 3 and 6 months. The results of the study are as follows: 1. The change of pocket depth and clinical attachment level in both groups was decreased significantly at 3, 6 months than at baseline(p<0.05). 2. The change of gingival recession in both groups was increased significantly at 3, 6 months than at baseline(p<0.05). 3. The change of pocket depth and clinical attachment level in both groups was decreased at 3, 6 months, and the change of gingival recession in both groups was increased at 3, 6 months but there were no statistically or clinically significant differences with both groups. 4. The significant reduction of the pocket depth and clinical attachment level exhibited marked changes at 3 months in both groups. In conclusion, the results of this study suggest that there are no statistically or clinically significant differences between fibrin adhesive and calcium sulfate barrier in the treatment of class II furcations using xenograft.

• Journal of Periodontal and Implant Science
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• v.27 no.3
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• pp.479-493
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• 1997

There are various treatment methods including barrier membranes in attaining periodontal regeneration and regaining the function of destructed periodontal tissues due to periodontal disease. Barrier membranes consist of non-Resorbable and resorbable types such as Dura mater and $Guidor^{(R)}$ used in the treatment of intrabony defects and classII furcation defects have been shown to be effectively increased the amount of new bone and cementum.In our study we used premolars with class III furcation defects created by removing the bone 4mm apically from CEJ in adult dogs and placed resorbable membrane Dura mater and $Guidor^{(R)}$ for the test group and flap operation was carried out for the control groups. The effect of membrane on junctional epithelium, alveloar bone, cementum, and gingival connective tisssue in the regeneration and healing potential of periodontal tissues was evaluated and healing results were evaluated histologically and histometrically 8 weeks following the surgical procedure. 1. In the clinical observation, there was no exposure of furcation defects in the control group, whereas slight membrane exposure was noted in the test group. 2. New bone was formed up to the level of the notch in the control group, whereas in the test group new bone formation was observed above the level of the notch. 3. New cementum was formed in both groups of the experiment. 4. The connective tissue observed between the new cementum and new bone in the test group were functionally orientated, compared to the irregular formation of connective tissues found in the control group. 5. Root resorption or ankylosis was not observed in any of the groups 6. The mean and median of the control group were 4.31% and 2.23% and for the Dura mater group were 27.85% and 15.57% respectively. There was no significant difference between Dura mater and the control group. 7. The mean and median of the control group were 4.31% and 2.23% and for the $Guidor^{(R)}$ group were 37.27% and 37.19% respectively. There was a significant difference in these two groups(P$Guidor^{(R)}$ were 37.27% and 37.19%. There was no significant difference between the two test groups. Thus, by using Dura mater and Guidor in classIII furcation defects, the predictable amount of periodontal ligament and alveolar bone regeneration may result.

• Journal of Periodontal and Implant Science
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• v.31 no.2
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• pp.345-356
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• 2001

The purpose of the present study was to evaluate the clinical efficacy of guided tissue regeneration(GTR) using resorbable polylactic/polyglycolic copolymer(PLA/PGA) membrane in mandibular class II furcation involvement and to compare it to the clinical efficacy of only flap operation. Both procedures were conducted in 5 patients with class II furcation involvements. After 6 months of follow up, the probing pocket depth, clincial attachment level, bone probing depth, and radiographic changes were compared, and the following results were obtained: 1. GTR using PLA/PGA demonstrated a statistically significant reduction in probing pocket depth and bone probing depth, and the control group demonstrated a statistically significant reduction in bone probing depth. 2. The comparison between the experimental and control group failed to demonstrate statistically significant difference in clinical improvement, but more reduction in probing pocket depth and bone probing depth were observed in the experimental group. The probing pocket depth and the bone probing depth were $2.2{\pm}1.6mm$ and $2.4{\pm}1.1mm$ respectively in the control group, while they were $2.4{\pm}1.3mm$ and $3.0{\pm}1.2mm$ respectively in the experimental group. 3. Radiographic change was not detectable for the both groups during the 6 months of follow up. 4. Sites with deeper probing pocket depth at baseline examination showed greater amount of clinical improvement in both groups. Other clinical factors didn't have any significant effect on the treatment results. It is concluded that though there are some limitations, PLA/PGA membrane is effective for the treatment of mandibular class II furcation involvement.